Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is rasagiline, and how does it work (mechanism of action)?

Rasagiline is an oral drug that is used for
treating Parkinson's disease. It belongs to a class of drugs called monoamine oxidase inhibitors (MAO) that also includes selegiline and tranylcypromine.
Monoamine oxidase is an enzyme that breaks down serotonin, norepinephrine,
dopamine, tyramine and similar chemicals that serve as neurotransmitters,
chemicals that nerves use to communicate with one another. There are two types
of monoamine oxidase enzymes, MAO-A and MAO-B. Monoamine oxidase inhibitors
inhibit one or both enzymes resulting in increased levels of the chemicals
normally broken down by MAO-A or MAO-B. Rasagiline inhibits MAO-B, but it is not
clear whether rasagiline also inhibits MAO-A. Rasagiline's exact mechanism of
action is not known; however, by inhibiting MAO-B rasagiline reduces the
breakdown of dopamine resulting in increased levels of dopamine in the brain.
Increased dopamine levels alleviate the symptoms of Parkinson's disease.
Rasagiline was approved by the FDA in May 2006.

Rasagiline also may
cause low or high blood pressure. A hypertensive crisis may occur if foods high
in tyramine are consumed while taking rasagiline. Tyramine in food usually is
broken down in the intestine by MAO-A in the intestinal wall as the tyramine is
absorbed into the body. There are no adequate studies in humans to determine
whether rasagiline also inhibits MAO-A; however, if MAO-A is inhibited, tyramine
ingested in food may enter the body in larger amounts and result in a
hypertensive crisis. Foods high in tyramine include those that are aged,
fermented, pickled, or smoked. Examples include aged cheeses, air-dried meats,
sauerkraut, soy sauce, tap/draft beers and red wines. As a precaution, foods
high in tyramine should be avoided when taking rasagiline.

What is the dosage for rasagiline?

The recommended dose of rasagiline is 1 mg once daily when
used alone (monotherapy). When combined with levodopa the recommended starting
dose is 0.5 mg once daily. The dose may be increased to 1 mg once daily if the
response is not adequate. Patients with mild
liver disease should not use more
than 0.5 mg daily. It should not be used by patients with moderate or severe
liver disease. Tyramine rich food, beverages and supplements should be avoided
while taking rasagiline.

Which drugs or supplements interact with rasagiline?

Rasagiline is eliminated by enzymes in the liver.
Ciprofloxacin
(Cipro, Cipro XR, Proquin XR) inhibits the enzymes in the liver that eliminate rasagiline,
thereby increasing blood levels and possibly side effects of rasagiline.
Patients taking ciprofloxacin should not exceed 0.5 mg daily of rasagiline.

Rasagiline should not be administered with antidepressants that increase
serotonin levels. Combining rasagiline with such antidepressants may lead to
excessive levels of serotonin and a fatal condition called the serotonin
syndrome. Examples of antidepressants to avoid include selective serotonin
uptake inhibitors (for example, fluoxetine
[Prozac, Sarafem], sertraline
[Zoloft]), tricyclic
antidepressants (for example, amitriptyline
[Elavil, Endep]), serotonin-norepinephrine uptake
inhibitors (for example, venlafaxine
[Effexor]) and other MAO inhibitors (for example,
selegiline, tranylcypromine). Rasagiline should be discontinued at least 14 days
before initiating treatment with antidepressants that increase serotonin levels.

Due to its long half-life, fluoxetine should be discontinuedhadone, mirtazapine
[RemeronSoltab],
cyclobenzaprine
[Flexeril, Amrix] dextromethorphan and St. John's Wort. Serious reactions,
including the serotonin syndro at least 5 weeks before initiating rasagiline.

Rasagiline should not be used with meperidine, propoxyphene
[Darvon, Darvon-N, Dolene], tramadol
[Ultram, Ultram ER], metme,
have occurred when other MAO inhibitors were combined with some of these drugs,
and there is concern that rasagiline may cause similar serious reactions.

Rasagiline should not be used with sympathomimetic amine drugs such as
amphetamines and products containing vasoconstrictors (blood vessel narrowing
drugs, for example, pseudoephedrine, ephedrine, phenylpropanolamine,
phenylephrine). Severe hypertensive reactions have occurred when such drugs were
combined with other MAO inhibitors. Patients taking rasagiline should not be
given cocaine or local anesthetics containing sympathomimetic vasoconstrictor
drugs. They also should not undergo elective surgery requiring general
anesthesia. Rasagiline should be discontinued at least 14 days before surgery.
Rasagiline should not be used with other MAO inhibitors because of the risk of a
hypertensive crisis. Rasagiline should be discontinued at least 14 days before
starting other MAO inhibitors.

What preparations of rasagiline are available?

How should I keep rasagiline stored?

Summary

Rasagiline (Azilect) is a medication prescribed for the signs and symptoms of Parkinson's disease. Azilect is prescribed alone, or in combination with levodopa. Side effects, dosage, drug interactions, warnings and precautions should be reviewed prior to taking any medication.